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8490 S Eastern Ave Suite B-1 Las Vegas NV 89123-2805 | |
| (702) 933-0971 | |
| (702) 933-0974 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8490 S Eastern Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Nicole Francoise Theuvenet (OWNER/PHYSICIAN) |
| Authorized Official Contact | 7029330971 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8490 S Eastern Ave Suite B-1 Las Vegas NV 89123-2805 Ph: (702) 933-0971 | 8490 S Eastern Ave Suite B-1 Las Vegas NV 89123-2805 Ph: (702) 933-0971 |
| NPI Number | 1487926010 |
|---|---|
| Provider Enumeration Date | 01/27/2012 |
| Last Update Date | 01/27/2012 |
| Medicare PECOS PAC ID | 3173859592 |
|---|---|
| Medicare Enrollment ID | O20190723003066 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487926010 | NPI | - | NPPES |
| 2019739 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 7846 (Nevada) | Primary |
| Provider Name | Nicole F Theuvenet |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972662393 PECOS PAC ID: 3173701133 Enrollment ID: I20110623000078 |
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